This week saw the release of the final report by the Commission on the Future of Health and Social Care in England, an initiative sponsored by The King’s Fund and led by a respected economist, Dame Kate Barker CBE. Having expended considerable effort in calling for greater debate on the sustainability of our health and social care system, you can imagine that I was just a little excited to see what they were recommending. However, you may have detected a certain negativity in my article title that suggests the experience of reading the recommendations fell far short of that anticipated in the run up. As far as a word-for-word reading has allowed me to determine, not only is there nothing fundamentally new but it appears to be absent of any comment on the actual settlement for healthcare (given the Commission’s title, this feels somewhat omissive) and makes no real attempt to address the true underlying root cause that gave rise to the need for a Commission in the first place. The start of any genuine leadership movement is a step away from the delusional idealistic to an authentic consideration of circumstances and their root causes. I can’t help but feel the we have here a tragic example of a lost opportunity that provides us with some very important leadership lessons and reminders.